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Contract 56363
CSC No. 56363 FORT WORTH CITY OF FORT WORTH COOPERATIVE PURCHASE AGREEMENT This Cooperative Purchase Agreement("Agreement") is entered into by and between Charm-Tex, Inc("Vendor")and the City of Fort Worth,("City"),a Texas home rule municipality. The Cooperative Purchase Agreement includes the following documents which shall be construed in the order of precedence in which they are listed: 1. This Cooperative Purchase Agreement; 2. Exhibit A—Seller's Quote, Scope of Services or Purchase Order; 3. Exhibit B—Cooperative Agency Contract(e.g.,NJPA,DIR,BuyBoard); and 4. Exhibit C—Conflict of Interest Questionnaire. Exhibits A,B, and C which are attached hereto and incorporated herein, are made a part of this Agreement for all purposes. Vendor agrees to provide City with the services and goods included in Exhibit A pursuant to the terms and conditions of this Cooperative Purchase Agreement, including all exhibits thereto. City shall pay Vendor in accordance with the fee schedule in Exhibit A and in accordance with the provisions of this Agreement. Total payment made under this Agreement by City shall be in the amount not to exceed One Hundred Thousand Dollars ($100,000.00). Vendor shall not provide any additional items or services or bill for expenses incurred for City not specified by this Agreement unless City requests and approves in writing the additional costs for such services. City shall not be liable for any additional expenses of Vendor not specified by this Agreement unless City first approves such expenses in writing. The term of this Agreement shall be for one year beginning on June 1,2021 and ending on May 30,2022. Vendor agrees that City shall,until the expiration of three(3)years after final payment under this Agreement, or the final conclusion of any audit commenced during the said three years,have access to and the right to examine at reasonable times any directly pertinent books,documents,papers and records, including, but not limited to, all electronic records, of Vendor involving transactions relating to this Agreement at no additional cost to City. Vendor agrees that City shall have access during normal working hours to all necessary Vendor facilities and shall be provided adequate and appropriate work space in order to conduct audits in compliance with the provisions of this section.City shall give Vendor reasonable advance notice of intended audits. Notices required pursuant to the provisions of this Agreement shall be conclusively determined to have been delivered when (1) hand-delivered to the other party, its agents, employees, servants or representatives, (2) delivered by facsimile with electronic confirmation of the transmission, or (3) received by the other party by United States Mail, registered_ , return receipt requested, addressed as follows: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX To CITY: To VENDOR: City of Fort Worth Charm-Tex,Inc Attn: Jesus Chapa,Assistant City Manager Steve Danger,VP of Sales 200 Texas Street 1618 Coney Island Ave. Fort Worth,TX 76102-6314 Brooklyn,NY 11230 Facsimile: (817)392-8654 SDanzger@a,charm-tex.com With copy to Fort Worth City Attorney's Office at same address The undersigned represents and warrants that he or she has the power and authority to execute this Agreement and bind the respective Vendor. [SIGNATURE PAGE FOLLOWS] ACCEPTED AND AGREED: CITY OF FORT WORTH CONTRACT COMPLIANCE MANAGER: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract,including By: J{sus J.Chapa(Sep 24,202113:12 CDT) ensuring all performance and reporting Name: Jesus J. Chapa requirements. Title: Deputy City Manager APPROVAL RECOMMENDED: fCe CC� � By: Kelly Cleveland(Sep 23,202114:31 CDT) Name: Kelly Cleveland Afa RIUako-y- Title: Acting Sr. Contract Compliance By: Neil Noakes(Sep 24,202112:22 CDT) Specialist Name: Neil Noakes Title: Chief of Police F°F�R r�aa APPROVED AS TO FORM AND 040°° o O%��d LEGALITY: ATTEST: ' 0040, Y�° °_ 0 dan�°�°000000000 EXpS��p By. Nico Arias(Sep23,202111:19 CDT)B y: y Name: Nico Arias Name: Ronald P. Gonzales Title: Assistant City Attorney Title: Acting City Secretary CONTRACT AUTHORIZATION: M&C: (None Required) Date Approved: Form 1295 Certification No.: N/A CHARM-TEX, INC. By: Name: Steve a ger Title: VP of Sales OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Exhibit A—Seller's Quote, Scope of Services or Purchase Order; QUOTE CI IARM TEX INC. QUOTE NO.., 0275560 1618 CONEY ISLAND AVE QlJ(3 fVDr1�E 7119/2021 BROOKLYN,NY 11230 7EL-(718)252-81.00 FAX:.(718}253-$303 SALF.SPERSO)N! GALL WEB,WWW.CIIAIttvJ-rEX:;COM CUSTOMER No.' 00-[ WORTH VALID TILL 08712?202I CITY OF fFORT WORTH CITY.;OF+FORT W0R`FH 200 TEXAS STREET 200 TEXAS 5'TREUT FOIST W0R'rH TX 7(102631 t FOR T�VORTI,TX'7G103li31:1 CONFIRM TO:A UA ROBERTSON ATTN TQ MA ROBERTSON CUSTOMERF0 *a up VIA F*13 TERMS' DELIVERED NET 30 DM S' ITE vI CODE: DESCRIPTION, ORDERED 11O*M _ PR[CE AMOUNT DISISNvFVM DISPOSABLE SF31Rr t3C3PUCKEI',NAVY,sizE 106: .CASE.. 7990 15%80. I+I"E:sDIIJ�vt,50lCAS�,` DIS1SN`VXL ITISI'OSABLE .S11tR1'; 1O FUGK.1.1',NAVY;IS1/L:YI,m W W`~T~~9,00 CASE„W M 79.90` `M H 719.i0 501CASE D1Sl81N V2XI, DISPOSABLE,SfIIRT;.NO POCKET NAVY:StLf2',L,.W 900.W CASE W 79,90 µ„ r~M719,10.' SWCASE _.. -- ._.........__ ..... ......... . ....... ........ 1)ISIPNVM DISPOSABLE;PANTS,NO POCKET;NAVY,SIZE,. 2.00 CASE. 82.90 165.90 MEDIUM,501CASE ..... __ _.. ._ .... l)I:S/PNVXL DISPOSABLEPANTS,.NOPOCKFT,NA'VY S),ZEX1.; 9.00 .CAST: 82.90 746:I0 50JC ASf DISIPNV2X1, DISTPOSA15LB PANTS.NO POCKET,NAVY,SI712XL, 0.00 CASE 82.90 746.10. 50fCAS3 lb ay 1warrt 186-19 Quoted as all of hone Ifthers Fs any change fo the above quantity when placing:your order;Please contact your sales iep,for the prices may change GIRDER 7'4TA.L• 3;256:00 Exhibit B—Coo erative Agene'�Contract(e g,N7PA,DIR,BuyBoard ; and : " # �..J..v . atiii•,_ � va Nvn3ax(t�+�$ Auslna,17F78i&7-IIddB.,. 808 6+15 2§..19 1 512.454022tf f ik.800;211,SA5d 'IruYbaard:aurr April29,.2019 Swt.Viia-Emailt kgallo@charm-tex.com Kathy Galio Charm-Tex 1618 Corley bland Ave: Brooklyn,NY 11Z30 Welcome to BugBoardi Re twice O"t.ne;Local Govemment Purchasfny CooperafsveAkWid` Rropoeat Name and Nurnl er;cc rre`ctionai'and Detention�ility Equ'iipmontand Supplies;2raposa1:tVo 586- 9 Congratulations,The Local Government purchasing Cooperative 4Cvaperatnre}has awarded.your company a; EfuyBvar contract based on the above-referenced F':roposal 'The cagtraet ts. ffefve 6YIY2019 iiiraugh:. 5/31J2029,with two possible one year►newels The contract t#ocuments ire thaw�denfif rl lh Section 3 cf the•Gerierai Termsand Conditions offihe specificahans TO vii av the items�yaur cnn!palty has been awarded,pl ai a li_, khe pri�pasal tafa fahan No Swi on tht foliawiag wela sike www btiybaard cbrYslvendor Only items rrsarked as awarded ka}our oopany.can:be'soic! ill thraughth guyBpar!....:....... xn addition,onthis weissiteyau wftl�ind the.members£ip list:vvhich w provide; you.v�ith th-e names of all enUdes wiifi mI'llembership'.in.our purchasing cbapera iae. : Endosed:with this letter you`v.Wll find the fa How Eng documents. I. lteridar Q fek lteferer ce Guide. 2 SuyBoar4[icense grid Identity Standards You are advrsed that receipt of a purchase order directly frop>E a Cooperative ntieenher:is not within it g€iid iinea of the Cocperatiue,..kccepting purchase orders directly from;Cooperative members.MAY result In a ivialetrori of the Sfate.of Texas competitive bid'siatuEe and termination of this Cooperative=SuyBoard contract. 1 heretore,ail.purchase orders must be prociassed tho"U.'the:Buyaa rd In aides to sompiy..Please firward by emall till infoi buyboard:cam anY order received directly from a Cooperative member;:If you iriadverteritiy process a purchase order sent directiyko yai by a Cooperative:member;please: fax the otder to the above`number.a►id note it'a's REcoRD ONLY to pr*Vent Oupifaatiur€ As an:aWbrded Vendor a BuyBoued user id and password whi ie sent via,e-raail'Z to 3;tfusine:is: i3alyYs p!'ior tcs the starC oE'.ydur 4contraict: Gn beha.if'of the'f"exas Ass{Ciation of School Boards,we appreraate your interest:in the Coop v :and we are 16.6kin 9 fbnivard to o Y._ur participation rri: the. progiarri. If you have any questions, please contact Caoaeratiyo Rr�jcri rematt Staff at,: b9.5 291 . Sincerely.,. ArtE#fq�Wa.lki1215-. Department Director;cooperative Procurement . it5[t alG v�r isr�,?urct rsi alp r�l sartf eJC3 thet�sA4 al not d?w�r4casr�s asaga: •. Tetras lrirrr 21te err�7exasiu�socrzrtw t' rtrlswarualptexas�sv^?he a 5avwrvPaarrealk, s r��, r,�x,,;r„�a». Ftcrcrse�Ly '45�xs Taa.�c�c�tav"?aicsu+. Aphl,291i 2019' Sent Via:Erreili:kgallo@charm=tez;com Kathy%Gallo: charm Tex 1b18 Coney;Island.Ave: Brooklyn,,NY 11211 Welcome'to BuyBoarW.. Re• NotuLa bfm'hat>al Put>=hab'ing.Caapetative piggy BaaAwatd Proposal Name and.Number:,Cbnsctional and petention'Facili y Equipment and.Supplies,:Proposal Mb 586 19 Congratulations,The:Matronal Purchasing Coope.ratve(National Cooperahve� has awarded your ccmpany a:BurBoardQ' contract based an ttre`above-refeieneed Proposal As"provided,fonn the proposal and your Naftional,Piitehasrngboaperative; Vendor Award Agreement,you:are Guth-602ed to sell the'goods and services awarded under tlie,.Promit.,tti Natonal: Cooperative members in states`;other than 7ezas thniugh':tfre Buy0m The 6ontract fs:effktive;6fi/2019 ffircugh:: 5/31/2020.,vutth twC;possihle one year'renewals.. This National Cooperative rh6 be hipdist 1s:available at'our website Www.buvboard.mm Oadr: The list identifies the curreritMembers fhat may.'purchase;awarded goodsafidservbis under'your.'National Coopeiathre'Buy6oard:ctintract. You are;:advised that receipYtof a:purchase order d6cdy from a sii onal Cooperative member-..Is notwiii fn: BuyBoard;guiiielines AocepEing purchase orders directly from Cooperative members may result in a viojatron ofappltcable. co..mpe6trve,:procurement law,and termination of this,National Cooperative BuyBoatd contract: Thereforei ail;purohase. ocders:frnm National Cooperetive:membersmust tie,&6bessed'tfirougK'ttie BuVBoai;&Please..fomraril by'm-rribiI to mfo&th board mm ari '*der eeoe140d dihe6tly:'fr6m a Natibnel Cooperative.member. :If`you i[iadvertanfly'pinee"ss a: purctiase:order sent direcdy to you by`a Nat:oval'Cooperativemembert.,please.faz.:Eiie order 6o theabove'numker'and'hobe. Was PECORD.ONLYto prevenEdimiication. ,As an awarded:vendor:a BuyBoard user.,id and password will be:sent yia>.e mail, 3 business; days prior.to theatart`.of your'contractc .On behalf>of the National Cooperative,:,we are looking forward to your participation rn tfie;program: If you.'have any< cIuestjons..;Please bonfact`C000ereM p.roeur ementi Staff at 800+695 2919,:: Sincerely. ArturorSalina`s Department-Directpr;Cooperative Procurement gas:. .AU;Box 40 Artstm,Texas 7E7671Mt10 r. 8b4;S$5291J:•6uy¢oardcom i s EaoPerative:�p/Clissieg 12007 ltesearcis:Bnufevard. in,Texas 78750439 PH Bt)Q?695 23:1 FAX 800-21 -5454'buvboard eom RROP'OSER, AGREE MENT AND SIGNAT(!RE Proposal filame:Correctfdnal'.and Detention PftosalDue Dat�eJt'�p�nit! Date aritl'I"Irime;- FaC!lity EgUlpment'and Supplies. tktober 18;Zf118' t 4 00 I?Nt won of Proposal apgnjaW. Texas Association of School Boards;Inc. 8uy8oard t7epartnterit: Proposal Number., 12-007.kesearch glyd. Austin,TX 78759 AnficliggUO+Cbtr3 fltiuOcsard Meewq you Contract 3'itrte P01od June 1,2019.through May April 2019 31;2020 with bvo(2)possible one-year renewals. - G ���1e� Name of Proposing Company Date: Street:Address Signature ofAurhori Company Official: City,State,Zip Printed:Name of Authorized ompany Oflicla[ fit ~ Ssct� y? v s. Telephone Number iof.Authorized:Company Official Position or Titie of Authorized company Official z. ...... .. . . Fax Number of Authodied:Cbr.npany Offi€cla! Federal ID::Number r Page 8 oF61 PiopaSai FomwLOMWSVCS'v46:14 2al8 Coopnrat)ve./'arclrasing. 12t1Q7.Re Boulevard Austin,Texas 7875 2439 :PA:800•695-2919'..pAX:8OEi-211-5454.'buvboayd roiii VEN60R CONTI'RiGT N11" RMATION Company: ' fi `t w '(6K Sri r Vendor Contact fume.and Mailin g Address for Notices.Wof�,CG3�. Company Website (Q v.J ._c s.ram - --t c€ w Purehase.arc ers: All:purchase orders from Cooperative rnembers Will be available through the.Intern& vendors need Internet access and of least one e-mail address so that notification of new orders can be sent to the Internet contact when a new.purchase order.arrives An information guide will be provided to vendors to assist'them:with retrieving ttielr:orders;. Please;select:opi ions below for_recelpt of purchase orders:and.prouide titn requested inforittafiian 1.will use the iriternet to receive purchase orders,at ttie following address; i maid Address: G' LLa t"W - InternetContiact; (Y'O_� o Phone::,"7rd� 'x'r1 Sara :x CIS Alternate E-mail.Address; ::5 si Alternate internet;Cc>ntact; �-.�...i��:s' . �Phone:.` �-' �$��v �:•E�` [ Purchase orders may be received by the Designated i7ealer(s)'identifiedon my company's realer Designation€orm:as provided ro the Coopetative administrator:..T understand that my company,shall:remain: responsible ftirthe Cantraci and the:performance of ail pes%gnated DeaierS under"and in=acrortfance vritli`Lhe Contract. Aeairest far[?cotes f"RFV) Cooperative members will send RFQs to you lay e-mail. Please provide e-mail addresses for the receipt of'RFQss >=-man,address•,������' �C1��f�y��t �-Cr�,� Alternate E-mail Address 'L?'x y nrroiCes: Your company,will be billed monthly for the service:fee due under:.',a contract awarded uhi er.this Rroposa! Irlvitatlon All invoices are available on.the 6 yBoard wiabsite and -mail:notificatrori tNiil he serif when.them are ready to be rekrieve d Wlease provide the-following address,0onfiact,arid,e-mail..information`felt i*ceipt of service fee:: involces and related Page IQ of 51. FrOP%aVF.i 1rM GOMMJSVC.S 1 06.14.201B Cooperalfve Pu►chas7ng: 12U07 iiesearcli(3ouleuard•Austln 7exds 78'759 2430-PH.800.695.291.§ FAX:800-W-5454'.buy rd.mm,. Please dioas; Only Ari l..tri the.following options for: receipt of invoices and prouid+a the requests.d irieformation• P Service fee invoices and related communications should be providedl directly to my Company:at: Mailing address � t C 9r, lfxs A" Vepartmeni: State: Zip:Cotle: Contact Name; *� ` Phvnet Faic -�?4$ e2Dt5 E-mail Address: '5'� C Aj Alternative> mail Address: C, © Iri iieu of my company;;I quest authorize all service fee-irivoices to be provided directly to the following bluing agent**: Mailing address:'.C7epartinent. .State<: Zip Code.*. Contact thin e: Fiione Fax: E-mail Address:. Alternative' '-rmail.Address: ❑ .In lieu tof my corapanyi I request and authorize servlcx�.fee invoices to be provided to the Oeslgnated Dealer(s) receiving the purchase orders}to wh➢ch the invoiced seance:tees relate at the:address and contact information:designated on my company's.Dealer Designation form as provided to theOperative administrator.** **If lrendor authorizes a hitting agent orDestg ated Dealer(s).torecei0e and:process service fee invokes, in accordance aYfth the General fierirrs and:Coiiditint�s.of the Contract,Vwdor.speclflcat-acrcnrzwleoves Dart agrees that nvth/ng1h that desfgnatioir shalfrellev&Velzdor a Its respori$IbAitles and obligations vrider the L crntr,�ct lac/udlrt ,l)(tt rJdt 1f117itet�to,payme4t afall service fees vnderany.:Centract as varde f Yendar.,: Page ll of fil Proposal Forms CO MMAVO tr.Q64430Y8. Goo parafi ve.1'urclt�sfgg 12607 Research Boulevard•Austin,Texas 76759-2430 PW 84d-64S-2919: FAX:800-2117s954.bLW ra d mm. FELONY CONVICTION DISCLOSM ANDDES ARMENTLOER71FICATION. Fe uoiyy Cowa Tlorr D�sct oSu zE Subsection:(A)of Section 44.034 of the Texas Education Code(Notification of Criminal HistoFY of Contractor) states: A person or business Ontlty that enters into a.contract with a:sdmol district roust give advance notice to the district if the irersvn:or en'ownor or operator fias:been convicted of a felony: The notice must include a general.description of the conduct resul ing.nthe convictions of a felony," Section 44.64 farther states in Subsection (b): "A school .dlstrlct.niay terminate a contract with a person or business entity sf the:distric(determines that the person or business entity failed to give notice as required.by Subsection. (a)or rrtisreptesenter!the-conduct resulting in the.conviction 7Tite.distrtct must compensate tlie.person or bus€Hess entity for services performed:before the;.termination of the contract." Please chec.k ty)one of the follgvo i:: YMy company is a publlcly-held corporation,tAdwnce nonce require lent doits:not apply to publkly-he d corpor&on:a m y comparty rs not owned ar operates by anyone who has beenconvicted of a felony. rvly company Is owned/operated by the following individuals)who has./have been convicted of a felony: Name of Felon(s) . Details if'Conv[ction(s)-* ,r,,, _ Ry signature below; I certify that the above information is true,complete and accurate and that I am authorized.by my company to make this bertlfiCzl ion.. . 1- Company Mine Sigtrat ur.e of Aiuthorr,d;Company,()fficlal: Printed Name: DEBARMENT CEIaTIr-ICATI"iN Neither my cor[ipany nor an owner or principal of trry company has been debarred,sttsi3ended or.otherwise made iiaellgible for particlpatian in Federal Assistance programs under Executive Order 12549;"i)ebarment and Suspension, as described in the Feder1.al Register and,:lutes and Regulations: Neither my,company nor an owner or principal of.:my company is currently listed on the;government-wide-exclusions in SAM, debarred, suspended, or vtherwiso ekcluded by agencies or° declared ineligible under.any stahrtory or:regulatory authority. My::company:agrees•to immediately notify the CAoi?eratlu.e: and all Cooperative members with pending purchases or seeking Ito purchase.fon my col any if;irjy coriipany:vr an owner or principal is later listed on'the.governmer*wide.exclusions in SA , .or is debarred,.suspended, of otherwise excluded by agenaes or dedar!ed Ineligible under any statutory or regulatory authority. ay signature tielbw,T certify that the above is true,complete and-accurate and.ghat I am authorized by my company to.: make this Certification. Cony Netrte _ r Signature of Authorized'Company Official Printed Name Page.12,of$1 Proposal Forms GbtiMSVG5;v.05.14.2018 CAopersfivC!'aickesiny 12607 Itesearcti Soalegard Austin,Texas 78759-2439•PH 800-69r2919•FAX 8Q[3 212-5154•b +iaoard cow... FEt;Q(r[X CO tVIr TI01[DISCLOSURE A mAIME T ERTIPi<CATION FELONy Cortyxc77Ct�N D3scl(ssuiiit Subsection fa).of Section 44.034 of the Texas:Educadon Code(Notification of CrimmaTHistory of Conti"actor} states:"A persrrrr or:ouslne5s entity that eitCers into a contract with a school district imst give aefvance notice to.the.district If the person or an owner or operator has.been convicted of a felony. 'The notice Must.iInd de.a general description of the conduct resulting in the conviction.of a felony." Section 44.03.4 further states in Subsection (b): "A school d'rstrlct may terrrllnate a contract with a person or. business entity if the district determines that the person or business entity failed to give notice as required by Subsection: (a)o rnisepresente.d the condud resulting in the tonvicdnn. The district most compensate the person or business entity for seriices performed before the.termination of the contract." Please check(y)one of th fintlo ym, RrMy company is a publicly held.'corporation.(Advance notice.requiremea does'not:app[ tui publicly-i,eld corpora€;on;): My company is not owned or:operated by anyone who has:been convicted;of a felony. n rhy company is awned/operated by the i Mowing individual(s)who has/have been convicted of a felony: Name:of Felon(s)c_ Details of Convituon(s) By signature below, Y certify trial;the above information is true,Complete and accurate and tfiat I am authorized try:my company to makelhis cerdlicatlon.. Company Name Signature of Auttiarrzed.Company Offliial: Printed Name: DEBARMElYr CERTIFICATION Neither,my company nor an owner or principal of my company has been debaltedf suspended otherwise made ineiigipfe' for participation in Federal Assistance programs under Facecutive Order 12549;,"Debarment and 5uspension"as described: In the Federal,Register.and Rules and Regulations. Neither my company nor an owner or principal 0.my con patiy Is currently listed on the government-wide exclusions in SAMl debarred, suspended, or otherwise excludeii:by agencies or declared ineligible under any statutory or regulatory authority. Niy€oriipany agrees to iMirne..lately notify tine Cooperative and ail Cooperative members with pending purchases or seeking to_purchase:from my company if my company-bran owner or principal is later fisted on the gavemnyent-wide excl:usions:.in SANS, or'is debarred;suspendeilf or otherwise excluded by agencies:or declared ineligible under any statutory or regulatory:authority.. By.signature below,I:certify that the above is true,complete and:accurate and;that I am.authorized by my company to;. snake this cettficatiom Company Name Signature of Authorized Company Offidal Printed Name Page.12 bf 61 Propwa6Eorms COMMjNCS V,06.14.7618 r Gaop+�ra>fAve!'ar�haairiAy' 12 OTResear+h,6ouleYard AuStip,.TeXAs 78759-243g .PH:8{)f1 Cs9S Z919•FAX.:80f1-211-5454 �iioard.cpm ` ORa BOvca�rT CErzc;iTiaN Effective September 1;2017 a Texas governmental entity may not enter into a contract with:a company.for-goods or services unless the contract contains a:Written veriflcation from the company.tiat it: (1)does not bopcott'.Israel;and(Y) will not boycott Israel during theterra ofthe contract,(Tac.GWtCori Ch:2270) .1%oyciitt Israel"'means.refusing to deal with, terminating business activities with,or otherwise taking any action that-isintended to penalize, inflict economic harm on,or fmit cornrnercial.relations specifically wrth:israel;or with a person or entity doing.business in Israel.dr:in an Israeli controlled territory,but:does not indude;ari.action made for ordinary business purposes: TEX.GOV`r Gobs=§80.g.tf01(1): By signature below,I cer tify and verffyAhat Vendor does not boycott Israel.arid will not boycott-Nrael during the term of any contract awarded:under this Proposal Invitation,that this certification is.true,compiete,and accurate,and that I.am authorized by my company to make this certification. Company lUame. Signature of Ali ized Cornpany.Official Printed Name NC1 E3tClLU©E6 NATIO CJR FOREraN TERRORIST ORGANIZATION CERTIFICATION Effective September 1,-2017,Chapter 2252 of the Texas Government code provides thata texas gove►nmental entity may not enter into a contract with a:company engaged. in active:business operations with Sudari,:Iran,or a foreign.terrorist orgariization Specifically,-any company identified ion a iistprepared-and maintained by:the Texas Comptroller under Texas Government-Code§§806.051,iI07.t151, or 2252.153 (A company that the U.S.Government affirmatively declares to be: excluded from its federal.-sanctions regime relating to Sudan;Iran;.or any federal sanctions:regima relating:to a foreign terrorist organization i5.rot subject to the•ccontract prohibition:): By-signature belawr I certify and verify that Vendor is not an the Texas Comptrollees.list Identified.above; lira:this certification is true,°complete and accisrate;and that T am authorized`liy rriy comPany'ta make tfiis certification. ,company NaM6 _..... j . signature of AuthOiTzed,Company Official Panted Name Page 14 of 61 fto6sal romu eOMMIsms v oG.ia.apts . CbopererCive.Par�h,�sing 12007 Pesearch Boulevard`:Aus In,Texas 78759-2435 PH 800-695-2819 FAX:BOO.-21I-5454 buvtioard.inrn .HISTORA,RALLY V DERUTILIZED BUSINESS C.ERTIFICA iRON A proposer that has been certified as a Historically Underutilized.Business(also kr OW6 as ar Minority/Women Business Eriteiprise or"`MWBE."and al referred to:in this farm as a"HUB", is:encouraged to.fridicate.its:HUS cei iHcation statit& when responding to this Proposal Invitation, The eiectroriic cafalogs All indicate:HUB cerq icatians.For vendors that properly indicate and-cioeument'their HUB certification on:this form. Please check(z/:Y.all that apply i T cer*:that my company has been certified as a HUB in the following categories: ❑ Minority f Wned Business we men own edr Business Service-01sabiled Veteran Owned Business (vegan defined by 36 U 5 C §itF1(Z),who'haS a servic connected disability as:defrned by 38 l S;C.$1t7 (7 6�,wind who Ms a disability rating, of 2t}0 or more as determined by the u.S;pcpartment of Vekerans Affars.or Cfeparknerat of Defense) Certification Number; Name of:Certifying:Agency: t �t u3 .t C:i.-e My company:has.NOT been certified:.as a HUB, By signature below, I.certliy that'the at3ove is true, complete anti accurate:and that.I am authorized by my Co me rnaite:thlscerti�cation. Company Warne. Printed Name y� signature.of Authorized Company Official Page I5 of:bk PMPSal:FOMKCCMMMCS V.06.14,2018 CaoperefJre 1'urrhas�ng: 12067 Research Boulevard`Austin,Texas 78759-2439: PH:SW695-2910"T'A7C:8004A 4 . 174tyi?gard.coiri A contract awarded under thls Proposal invitation covers only the specific goods and services award ad by the HuyBoard.As explained. In the BuyBoard Procurement and Construction Related Goods;and Services Advisory for TexasMembers ("Advisory'), Texas law ptiyliibits the procurement of at hiteCture or enorneering services. through a purchasing cooperathre.This.BulyBoard:contract does Aot intrude such serVi+Ces,ltr+Cltitectare or erhgineerino servicas must be..procured 'by a Cooperative member separately,,in.accordance;with the Professional Services.Procurement Act(Chapter 2254.of the Texas Government Code)and_other appiicable.law and local, Policy. The Advisory,available at b�board comNend_q Resources.aspx, provides an;overview of certain:legal.requirements that are pofientiatiy relevarit`to a Cooperative membett procurers ent of construction or corjsituctlon-related:gpads and seavices,: including those for projects that may.Involve or require architecture,engineering or independent testing services. A copy: of the Advisory can also be provided.upon request. By signature below,the undersigned affirms that Proposer has obtained a copy of the Advisory:;has read and understands. the Advisory, and Is:authorized by Proposer tis 'flake this affirmation. If:Proposer sells corisfiructirtn-related. goods or services to a Cooperative member under a SuyBoerd contract awarded under.this Proposal Invitation, Proposer will coinpiy with the Advisory and applicable legalxequirements,make a-good faith effortto make:its Cooperative_member:customers or potential Cooperative member customers aware of Such requirements,and provide a Cdoperad.ve member with a:copy of the;Advisory before executing_a Member Construction Contract with the member or accepting the:members purchase order for construction-related goods or services,whichever comes first. company Nairn Signature of Aut zed Cbmpany Official Panted Name Date: Page 16 of(a .. `.Proposal Forms.oomwsvcs.ux&14,2618 RPntclrasfng. 12007 Research Boulevard: Austin,Texas 7$7�4 2439 PH 800 G95 2919.•EAx;BOQ=2f15454' u rd rag�,- DEVIATION AND COMPLIANCE: If your company intends:to deviate from the General Terms and Conditions,Proposal Specifications or other requirements associated with i P this roposa!Invitation,you MUST list all,such deviatipns on tfils form,;and provide complete and detailed. information rmgarding tfie deviations on this form or an,attachment h.this: form. The Cooperative will consider'any deviations in its contract award decision,and reserves the right to accept or reject a proposof based t tpori any submitted deviation. In the absence of any deviation identified and described in.accordance wkh..the.above,your company must fully comply with the General Terms and€ndittoris,proposal 5pecidcatians and.all other requihmehls associated vtiith this Proposal Invitation if awarded a contract:under this Proposal.Invitabon. .A deviation will not be effective:unless accepted:by the Cooperative: The Cooperative rrtay :ln Its-solo dikdx on,seek darifitation`from and/or corltmunlcttte with 1?roposer(s) regarding.any submitted deviation, consistent:with general procurement principles of fair competiiin. The-Cooperative reserves the right to:accept or rej i;a proposal based upon any submitted deviation, iyl_eassee check(SIT.one of the followlna: l#�' G;Deviations Yes;:Deviations. List.and:fully explain ally deviations you are sUbmitting:: PLEASE NOV E"THE FOLLOWING INHO ATI N.- L shipping via..N16mrnbn-Carrier Q Company Truck ❑Prepaid and Add.to Invoice Cl Either. 2.Payment Terms:2 Net 3o days E 1°In ih lOjNet 30 days E;Other, 3.Number of Days for Delivery:: ',:Rf_ARO 4.Vendor RefereiicalQuote NUMber: 5.State your return poiiey.. '.b44 (M Olimifjj 6.Are electronic payments acceptable? es :O No 7.Are credit.card.payments acceptable?QX 'Q No cbmpany:Narrie .r + . Signature of Aut d:Company OfEiciai, Printed Naive Pag'e 17 of 61 Pro�p531 ParYns COMM(5VC5`v:Obi24.7A28: Ct;'trA9rafFve'Plrtchaslag I2007:Research Bntilevard'AusGii 7eXas.7$759 24a9: PM:$Ofi-655.2 �:FAX;80D-21i.5.4%E huyboard:com LOCATION/AUTHORIZED S`ELL R .ISTTWGS If you have more than one locatiOn/authorized seller iftat will service:a::contract at�rarded under this Propnsai Invitation; please list eachlocation/authorized seller below. Ifadditional sheets are required,.,please duplicate this for .as necessary. MOTE: Awarded Vendors shah remain ir-sponsible for all aspects of the Contract;.hn ludlrig processing of Purchase Orders; and shall be,responsible for the:performance of all locations and:authorized sellers under and in accordance.with the Contract. If you are a'product manufacturer and wish to designate:Designated Dealers as defined in the General Terms and Conditions to receive Cooperative member;Purchase Orders on..your befialF, yoia must complete the:Manufacturer Designated Dealer form.. Company Name icity State zip. Phone Number Fax Number Contact.Person: Company Name Address City State Zip Phone Number Fax Number' Contact Person Page 18 of 61 ROyPOsal FOrms 0OMMj5VCS:v:06'.K2018 csoporarira t'uch�sing. 1207 Research anulevarii AUsiGiy Texas.78759-2�+39 PH.800 G95 29Y9: :FAX;8Ot1211 595�i:F k+uyboard corn LOCATIOm1AUTHORIZED SELLER 4 STIN S If you:have more than one toratlonJautliorized seller.that wlll service A.contract:awarded under this:Proposal:Invitation, please;list each locatianJauthorized seller below. $f additionaj sheets are required,please duplicate.thls farrn as hedessary: No'fE:. Awarded Vendors shalt remain responsible for all aspects of the CanCract,including processing of Purchase Arden,. and.shall be responsible for the performance of ail locations and authorized sellers under and In accordance ICh the Contract. If you area product manufacturer and wish to designate°Designated beaters as defined to the General Terms and Conditions to receive Cooperative member Purchase Orders an your behalf, yciu.must complete the...Nianufacturer Designated.Dealer form.. Company Marne Address City State/ ,Phone Number Fax Number ContacC Person Company Name Address City State Zip Phone Number Fax Number' Contact Person Page 18 of'b1 PrOPOW-romrs COMM XS V.06.143g1$ 12007 Research:Soulevarl3'Austin,Texas 78759-2439 y.PH:.8Q0 69S 2919=FAX.800-211-5459 tiuvfxiard coin TEXAS R;l GIONA . SMV_I-CE DESIG MATION. The Cooperative(re€erred to as'Texas Cooperative"i.n:this form and iri the`State Ser.vice Desagnatloii forml..offers.vendors the.oppottunitY to service its.members'throughout the.entire State.of Texas. if you do not plan to service.all Texas Cooperative members statewide,:youmisst indicate the specific regions you.will service.on this form. If you propose to serve different tregiorrs.Pordifferent products or services fnclodeti In,your proposal;..you must complete and sabr»It a.s¶te Texas Regional Service Designation,form:for each yrovp of products and.claarly fndleate the products or services to whfch the deslgnat/an applies in the spar e pravlrled at the end of this form; By deslgrating:a rey/an or regions, you ate certifying that;you ,s areuthorfed lid svlUing`fa.provla'e the: proposed products and services!n:those regions. tiofgnating regions In o'bich you are either unable or univ1111ng to provide the specified products and services shalt be;grounds fir either rejection of your proposal or, fawarded,termination>of your:contract. .Addltlonaily,if you do not;plan to service Texas Cooperative. members(U, if you will service only states other than Texas),you.must so indicate on this forth. Re04nai Education Servio C n ers I'w�i1;senrce.'Texas Cooperative.meMbers =�° statewiille, I wiff not sennce Teitas �ootserativEa rnentbers s 3 statewide: I itzriii.a►Ny seirvice meinber in the J� idns:cb ci>;ed bel+xw . E: Regigo b liearte�s 1 >rdtn urg z 2 Corpus Christi . n. r ❑ 3 Victoria 17 4 Houston M 3: Beaumont ,13, 6 Huntsville :..^, a b�-. .� � � 7 Kilgore 8 Murk Pleasant 13 9: Wichita Falls to Richardson. Fort Worth '�$ •. 17 12 Waco Austin ` 14 Abilene 13 1s Sari Angelo ` 0 16 Amarillo 0 17 Lubbock. Company Name CI 19 El Aria 20 Sari Artario. Signature of Authokz. Company Official L1 1 will.not service members Printed Name of the Texas Cooperative: Page 20 of 61 • r><opasat:i•ormsci+vy/svcsv..os:i4;zosa ' CanpBiaiSi�re/'trt9Ci+(tlxing' 12007 Research Boulevard AmUn,Texas 7875.14439 :E'H;806.695 29i9'FAX 800�21175454 buy6oa tl':com If this Texas Regianai Service 1}esignatlon°form applies:to only orie orsome of the produc€s and services proposed by Vendor,list the products and services to which this,form applies:here: Page 21 of 61 .PrOPOS l ftmr Co AWSVCS v;66.14.2618- CoAperafiva°Paraha�ing 12007,Pesearch.Boni rd'Ausdn,Texas 7$759 243$ PH:800:b95-2915"FflX:8©0 21T-5454=buvbo ftf Coii1 '5:TATE SERVICE..DESIGNATION The Cooperative Offers vendors the opportunity to service other ggvernmental entities:in the::united:States, including intergovernmental Purchasing cooperatives such m the National Purchasing Cooperative BuyB ar€l You must complete this form if you plan to service'the'entire United States,or will senfice tiniy the sperific;states indicated. ;{looter Zf you plan to serllce Texas Cooperative members,be sure that yau complete the Texas Regional5en4ce Destgnatron torn:) If you serve different states for dtffererrt products or services Included 7n your proposal;ytru must complete and subrrttt a separate State:Service DesignatJon faun for each graup.ofpraducts aril cJou m lndicmp'ehe products.or cervices to cvhiclt the d�signatJan:applies In the space:prvvlded at the efid of this.farm: By; designating a state or states,you are certifying that you are authorized artd ctriJling to.pr4.Wde the proposed products and services in C/rose states: Designating states In whJCh YOU are either unable or.unrollling:to provide the specified pfVdVCts and servtCes.shall be grounds for either re1ectton of.your proposal or if awarded,termination ofyour.Contract Please hat awls I will service all states in the United States. r ❑ 1 will not service all states In the United States. Twill service only the states checked below: Alabama ❑ Alaska ©Nebraska Arizona ❑Nevada ❑ Arkansas ❑New Hampshire Califomia.(Public Contract Code 20118&20652) ❑.New 7crsey Colorado: ❑New:Mexico n Connecticut ]New York ❑ Delaware ❑North';Carolina . ❑ District of Columbia ❑North bakota ❑ Florida ❑Ohio ❑ Georgia ❑Okla}iorna. ❑ Hawaii El Idaho ❑'Oi-egan Illinois ❑Pennsylvania Indiana ❑.khode Island FI ❑South ❑ Iowa butia Kansas El Dakota ❑Tennessee 13 Kentucky ❑Texas H. Louisiana ❑.Utah. Maine ❑vermonf' Maryland ❑Virginia ❑ Massachusetts ❑Washington ❑ Michigan West Virginia: ❑ Minnesota ❑Wisconsin Mississippi ❑Wyoming ❑ Missouri ❑ Montana :Page 22 of 61 Ptujxsai�wmsCpain�/svcs v:os;�a.zose NO caapsrntfr�rrrrtsris SZOE17 Research.Boulevard Aits#in,l exas 78759 2439'Pii 80Etab95 2419*FAX:,SM211-5454.•huvboard eam. . This form wl be used:to ensure that you can service other governmental:entities th* gliouC the United.States:as indicated. Your signature below confirms:that you,understand your service Comm tments.di3ring the term of a contract awarded under this proposal. Company Name Signature of AA ompany Official Printed Name- If this State Service.-Designation form applies to only.one or some of the.products:and.services proposed by Vendor, list the pr6ducts and';services to which'this form.applies here: Page 23 of 6! ProposW.Forms.COMWSVCS v.06;14:2018. boa,paraf►rg.Pureltusigg 12007 i;eseorcfi Boulevard Austin,Texas 78759 2439 :PH>BiiQ 655-2979, f�X:8Qi}2 i-S�15�}•_l� rho r ` NATIQNAL I U# GHASING Ct}3P RAMEVENOORAwARD AGREEMENT IYi accordance with:the Terms and Conditions associated with this Proposal Invitation, a contract awarded under this Proposal Invitation may be "piggybacked"by another governmental.entity: The National Purchasing Cooperative is an intergovernmental purchasing cooperative formed by certain.school districts outside of Texas to..serve its thembers throughout the United States, if you agree tcs be considered for apiggy-back award by:the National Purchasing. Cooperative,you agree to the following terms and agree to serve National Purchasing Cooperative members:in:the states you have indicated on tie 5tate'Service Designation form;in your.Proposal. By sloning:this foi*itii,Prapaser(referred to in this Agreement as:"Vendor")agrees as foitows;: f. Vendor aciurow(etlges that The Local:Government Purchasing Cooperative (`.Texas Cooperative„).awards Vendor a contract under.this Proposal.Invitation rUnderlying'Award"),the Natloiial.Purchasing Cooperative("Nationai`Cooperative'l may but is not required to M"piggy back"on or re-award all or a portion of that Underlyiing Award("Piggy-Back Award'). By signing this:National-Cooperative Vendor Award,Agreement("Agreement"),Vendor accepts and agrees'to be bound by any such Piggy--Back Award as provided for herein. 2. In the.event National :Cooperative awards Vendor a Piggy Back Award; the National Cooperative Administrator {"BuyBoard Administrator') will notify Ven dor In writing of such Piggy-Back Award,which.award shall commence:on the effective date stated in the Notice arid end on.the e5 piratiar date of the Undetiying.Av ard,subject to:annual renewals:as authorized in:+ranting by the BuyBoard Administrator. Vendor agrees:that no fu tier signature or other action is required of Vendor in order for the Piggy-Back'Award and this Agreement to be binding upon Vendor.Vendor further agrees that no interlineations or changes.to this:Agreement by Vendor will be binding:an National Cooperative;.unless such changes are agreed to by BuyBoa€d Adminittrator:in.writing. 3. Vendor:agrees that it shall offer its goods and services to National Cooperative members at the:same unit.priC[ttg:and same general terms and.conditions;subject to:appliicable'state laws in the state of purchase,as required by the Underlying Award: However, opining in.this Agreement prevents Vendor front rifferrng National Cooperative mernbers'better:((.e.,. lower.)competitive pricing and more favorable terms and conditions..than those In the Underlying Award. 4 Vendor hereby agrees and confirms that it will serve those states It has designated on_the State Service Des gnotion. Form of this Proposal.Invitation. Any changes to.the states designated on the state service besignation Form must be approved in writing by the BuyBoard Administrator. 5. Vendor agrees to:pay National:Cooperative the service fee provided'fer'in the:Underiying_Award based.on the amount:of purchases:generated front National Cooperatrve members through the PiggyWBack Award. Vendor shall remit payment to National Cooperative on.sucfi:schedule as°it specifies (which shall not he .often than.monthly).: Further, upon request,Vendor shall provide National Cooperative with copies of all.purchase orders generated from National Cooperative members for purposes of reviewing and verifying purchase activity.. Vendor further agrees that National 'ooperative shalt have the right, upon.reasonable written notice, to review.Vendor`s records pertaining to purchases:made by'National Cooperative members in order to verify the.accuracy of service fees. 6. Vendor agrees that.the Underlying.Award,including Its General Terms and Conditions,:are adopted by reference to the fullest extent such pruvisibns. can reasonably apply to the post-proposal/contract award phase. The _rights an responsibilities.that would ordinarily inure to the Texas Cooperative pursuant to the Underlying Award. shall.inure to National.Cooperative;and,conversely,the rights and:responsibilities that would ordinarily:inure:to Vendor in the Underlying Award-shall inure to Vendor in this Agreement.Vendor recognizes and agrees ihat Vendor and National Cooperative arethe only partles to this.Agreement, and,that nothing in this Agreement has appi cation to,.otheIr.thlyd parties;;including:the Texas Cooperative. In th.a event of conflict between this Agreement and the teiltts ofttie Underlying:Award,the terms of this`Agreement;shall control,and:then only ttt the extent necessary too reconcile the corrftict. Pruposal:Fanris CODSMj55tC5:vtr6.b4.2{It8 Page 24.of'fi1 Cui�perett�rg Purtihfiig' 12007 Researi Boulevard AustJit;Texas.787$9-�43� PH:.SOC#Bi3S-29E9`FAXi 8D0-2i15�54!:;6S��p� 5 7. This.Agreement:shall he governed and construed in accordance with the laws of the State of Rhode Island`an&venue for any dispute shah ile:ln the federal district court of Alexandria,Vlrginla. S. Vendor acknowledges and agrees that the award of a Piggy Banc,Award"is Within the.sole discretion of Natlonal 661)eratiVe,and that this Agreement does not take.effect unless and iintli National Cooperative:awards Vendor a W9gY- Hack Award and the SuyBoard Administrator notifies Vendor in writing of'such Piggy-Bade.Award as provided for herein: WHEREFORE,by signing:Below Vendor agrees to:the foregoing and warrants ti at.it has.the authority to enter into this Agreement, Name of Vendor Proposal Invitation Number Signature of Auth: Company Official Printed.Name of Authorized Company Official: Date: Page 2-5 Of&1 pwosw Fomu COM61M S 06,14.2018 L"aiiR�aliVa`PUrcN�nigf 12007 Research Boulevard:-Dustin,Texas 787%2439 ;PW 800=695-2919•FAX;80II-I"t 454•bjtyjjgar�3;�o�n EDERAL ANb STATE PuRCHW 00PERATIVE EXPIERIENCE The Cooperative strives to provide its:members with the best services and products.::at.the.best.prices.available from. vendors with the technical.resources and ability to serve Cooperative members. Please respond to the following:questions: 1. Provide the dollar value of sales to or through purchasing cooperatives at or based on An estabiished cataiog or market price during,the previous 124month period or the last fiscal year: $��,.:?yo��?�(jb .pedod of the 12 tnontil period is ` (iVt4 1, lot t a). In the event that a dollat.value is.not an approprlate rneasw*of the sales,:. .provide and describe your oven measure of the sales of the item(s). 2: By submitting a.proposal, you agree that, based on your writterti discouriting policies, the.discounts:you offer the Cooperative:are equal to or better than the best price.you.offer other:purchasing:cooperatives.for the same items under equivalent circumstances: 3. Provide the infotrnatloh requested below for other purchasing.:cooperati:ves for Which Proposer cuirenCly.selves;or ri the past;has served, as an. awarded vendor.. Rows should be added to accommodate as.;many. :purchasirg cooperatives as required. VENDORr PURCHASING ENDOR? IF YES, LIST YEARS 1 Federal Gehera(Seivices Admiriistratian 2:T=PASS(stabebrTexas) 3.U.S,Communities.Nnhasi lg Alliance 4..National IPA[TCPI+i. -` S.Houston.Galvestari:Area Council(HOAc) 6.National Joint Powers Alliance(N)PA) �[ 1� 7.EW Cooperative T 8:The Interlocal Purchasing System.{TIPS} 0 MY COMPANY ROES:NOT CURRENTLY hiAVE ANY OF THE ABOVE O.R SIMILAR,TYPE CONTRACTS. CURRENT BUYSOARD VENDORS If you are a current BuyBoard veridor.in the same contract.category as proposed in.this.Proposal'.Invitation,:indicate:the: discount for yorai"current BuyBtidiCl tOntract.ancl the proposed discount'in this Presposal,. eviai.n any difference between your current and:proposed;dikounts. st Cunwt Discount(.n1n) t d o Proposed Discount(°lo)y. ' t F.xplanatian .. Page-26 of 61. Proposal Foems coMMAVCsv 06.112Gis i ard- CY AU Cridperatty'Aftech"Ing 12007 Research Boulevard`AusUn,Texas 78759-2439`PH`E30Ll-095 7519:•FAX.$00 Z7.1 54:".Ik Cl Q!S3 By signature€below,I iwW that the above.is true,complete and accurate and that I arri authorized by my company to make this certification'. _.rrorripariy Nar<ie Signature of Auth zed Company Ofrciai PrinLd Name Page 27 of:61 Prbpmal s ms cbmw vcs 4;06.14.2018 Cnoperatlrre Pgrchaslrrg 12007 Research,gpulevard'Austin,Texas 788759-243.9`:PH;800-6954319-FAX:$00-211-•5454.'l&yboard<gons. GOVERNMENTAL REFERENCES For your Proposal to be:considered,.you must supply a minimum of five(5)individual governmental entity references. The Cooperative may contact any and all references provided as part of.the Pro pisai evaluation Provide the.information. requested below,:induding the.existing price/discounts you offer each customer:TheCoopprative may determine whether pries/discounts.are fair and reasonable by comparing prices/discounts stated In your I Pt&oposai with the prices/discounts you offer other goverrimerital customers, Attach additional page*.Ifnecessary, QuantityI D Address Discount l m 2, 3. 4: 5, .Do you ever modify your written policies or standard governmental sales:prack(c s:as identtW in the above.ehart to.give better discounts(lower prices)than indicated? YES EINO 5;please expiaim. By signature;below, t.certafj that the above is.true and correct and that`T am authorized by.my-company to make this certification. Gs &N-, Company Name Signature of Authorized G pang Official Printed Name PrOPMal RMS COMWSVG5 4.06.14.2018 Page 28'of 61 f �kk I i REFERENCES 1 Christian County.tail j 410-VU.71TM:5treet,Hapkinsville KY42240 Contact Name_Captaint)avyBiird l Phone:270=881-4152 Email-.davv.burd aa.0 Jajt or,3 San Francisco sheriff 850,8"nt Street,San Francisco CA 94103 Contact Name:Chong Low Phone.-,415-553-1055 Email:sau IawOs1•aov.orst E Alachua County Jail 3333 WE 391".Ave,Gainesville FL 32609, Contact Name.Kris Allfrey Phone.-3s2-4414560 Email:Wiftevaacsom, Madison County Jail 81$.Wheeler Ave,Huntsville AL 35801 Contact Name:Paul.krguson Phone 256-519-4824 Erna€I usoneo;madison;alus City$i Countyo#Denver Contact-Warne.Angel OFUZ 105M E.Smith'Road,Denver CO 80239 I: Phone 720 9U-4�28 Email-angel ortMdenveraov.ora Company Name:St i.oulsCityJasbce Canter Address.20f)South Tucker Blvd.,St.Louis MO 63102 Contact lance.Evans Phone 314 6215a84a Email:EvanslCastbuls-tmo=. 1619 Coneys island Ave,Brooklyn NY 11230 1..80t3.22131447 www.Char.m-.Tex,.com i rdepe at"ptra l9 shm 120f}7 Restx7rch Boulevard Ausiri,Texas 7&759-2439.PH $Ut169S 2919'•:EAX:8U.0-23E=5454.:4u+thoard.Com MARKETING.SITKATEGY For your Proposal to be,eons"tdered ou must submit the.Nlarlce3an Sfra ou will use if the Goo erative aece: all or: Attach additional pages if necessary. U! . �� sF _ �C+ 1 A y£�. t�3Jrxf.. a. ail —lrt � d �yr Sa@ C4 'olt C*S nn c r1 Company Name J Signature of ilthortlEd Printed Name Proposal Forms CCMMISVC5 11.0G.14.2b18- Page 29 of 62. ,. Crhrp�ratti'v�Ptiri:h »g 12007.Research:Boulevard•Aust9ti,Tafcas 78759 243g PH;800 695 2g19'FAX;8CItl Zl i-5�54`.�i Ybaard:cdm CONFIDEPLnALIPROPRIgnRY INFORMATION �:..P.>~klic>Diisolosare Maws All Proposals, forms, ddcumer tationi or other .materials submitted by Vendor to the cooperative in:response to this Proposal Invitation, including catalogs and pricelists,May-be subject to the disclosure'requirements of the Texas Public Information Act Crdxas Govemment Code chapter 552,001; et seg:_).or similar disdosure law. Proposer,must clearly identify on this farm any,Information In its f'roposaf(induding farms;.documentation,Of other materials submitted.with the Proposal) that Proposer.considers.:propYretary or confidential'. I Proposer falls to property identify the infoormatten, the. Cooperative shall have no obligation to notify Vendor at seek proWcction of such inforrrration(rani p ublic disclosure should a member of the public or other third;party request access to the information under the Texas Public.info rmaElori Act or' similar disdosure taw:. Proposer will be notified of.any third party request for nformation:iti a Proposal Proposer has. identified In this form as proprietary or cbr fidentiat. Does your Proposal(including forms,documentation,or other inaterlais submIded with the Proposal)contain:irifornradon which Vendor considers`propriew y or confidential? Please;dieek(Jl bna cif di foHnwrnn: NO,i certify tW:none.ofthe information included with this Proposal'i$cpnsidwed confidential or proprietary: YES,I'certify that this Proposal contains.infarination consldered confidential qr proprietaty.;and all such information is Specific liy identlfied.oh this form..; If you responded"YF5",you musk;identify below the-specific information yoU coitsader confidential or proprietary: :List each. page,number, form number,or other:information sufficient to;matte the inftiitiiation readily identifiable:: lne Cooperative .and its Administrator will riot be responsible far a Pr'oposeA.failure t6 dearly identify Snformation.eonsldered confidenttat:or proprietary. Further..by-submitting.a Proposal,Proposer.acknowledges.that::the Cooperative arid'its Administrator Will disclose information,when.required by law,even if such information has been Identified.herein as.information:the vendor considers confidential or.proprietary. Confidential/Proprietary'Information Si Ja,r. c;n tr (lfltath atld�liana/sheetsifileeded.J - FropgsMAUMs.CDMD1/SVCS vA6.f4.2018 Page 30 of 61 12007Research Boulevard•Austinr:Texas 78759-Z439 Pii:800 695 2919`FAX:80a 211-5454' r gfttm: Gogyridht Intbrination Does your Proposal (including forms, documentation;or.other materials sutirnitted with the Proposal) contain copyright. Information? Pie,�vge rh�ctc ttl 4.i���St1R f'zi vaiira- ,. NOT Proposal(including forms,:.documentation,orother materials,submitted with the Proposal).does not: contain copyright information. Q YES,Proposal.(induding'frriTis;documentation;or other rnaterlals submitted with the Proposai)does contalri copyright information. If yoU responded`YET;:identity below th.e spedfic documents or pages containing copyrigfit jnformation. Copyright Information: (Attach�dditicrr�t s/iee�sJineeded J C.Consent to'Release Confide ti#a1 Pronri L l+r+9htTnforsnatiorrto 8uy13oarc!Members BuyBoard members kitooperative.and nonprofit members)seeking to make purchases ttir.Wgh the.BuyBoard.may wish:to view inirtotmation includetf in the Proposals of awarded vendors. If you:ideritiiied Information:an.trims fo jri as confidential; proprietary,or subject W.copyright,and yoikare awarded a BuyBoard contracts your acceptance of the Buy0bard contract award constitutes'your consent to the disclosure of such information to BuyBoard rhembeM, including:posting of such information on the secure BuyHbard webske for members. Note:. Neither the Coo .nar its Rdmiriistrator will lid,. responsible for the vise ordistribution of lnfbrmation by BuyBoard members or any other party. 04 Cow rlfi#r Release NmposW Dbulatfon., Notwithstanding anything-in this'Confidential/Rropdetary information form to the contrary;.by submitting a Proposal;. Vendor consents and.agrees that,upon Contract award,the Cooperative may publicaily.release, including posting on,the Public BuyBoard .wehsiie, a copy of the proposal tabulation for the Contract Including'. Vendor name; proposed. catalog/pricelist nathe(s), proposed percentage discount(s), hiourly:labor rate(s), or mincer specified pricint#, and Vendor award or non-award inforrnation. By.,signature below,I certify that time information in tE is form Is true,complete;and accurate and that I am:authorized by my company to make.this certification and:alf consents and agreements contained'herein: Company Name Signature of Aut g' Company Official Printed Name Date. . Pr"uiixal�+iim5,EOMM1t(sVCS V QS.ffi.2o18 Page 31 of 61 Coopet�tJve Wbrchasin$ 12067 Research Boulevard•Art$tii;Texas 78759 2439 pki 80t1=695-? 15''"FAX:800-271-5454 Ibuvboard:eom VENDOR BUSINESS NAME: By mbrnittlng a Proposal,proposer Is seeklrig to enter into a.legal.contract with the COoperative: As such;'a proposer must be an Individual or legal business entity capable of entering:into a binding contract, Proposers, must.completely'and' accurately provide the lnforrriatiiin req testect'below or your Proposal'tray be deemed non4esponsive.. Name:of Proposing:Company C- kA�M "tvtie; S r t r. {Lstlfie�name.ofb�corriparry.�eetcfiu,�tr�ront2rtwfffit/teC'oaperalive.Do�p�')Istanassumedr3airr�dba,aka,ete:here 5urlsrnfcuinatfonmay Ge P&'"3d d below, rf yd1 are Af&nWtV v joint proposal wth another entity to prbi9pe tine some pmwsed 9�or s�rvlcts Garr#V 4i ptvt emay. should compktn a separate.vendor{reformation form; Separately opmdag Jegat buslr ess eatfties even if afiSJiated,endtfe�.:wtilch propose to:prgvxr q yoodror seMcess�varvtetymurtsubniit NreJYOwn Proposals.) New*thick bo one of ft fn[!o inay Type of Business. Individual/Sole Proprietor Corporation Umited;UabirftV Company Partnership Other If Wier,identify_ State of IncorpUrafiofi(iF appiieab(e). J 1f:Sn% `ask Federal Employer lderitificatioit.Number: (02ndarmust-include-a completed form with their propasaJ) Wt the Names)-.by which.Vendori If awarded wishes to be idenlAod orr tho.BuyBoardi .(Nate: if nt rhan:itie ivame or' Wrnpiisfng Company rsted above only valkf trade r arires dtia,ate et�f:of d e:PCapastns Cattipany roar ba rrsed arfd o.ropy e yaurA$$~rOA* F.ert' Aieate(sJ,ifappHcali/�:.siusCLe attad,ed.) Proposal-SOMIS C0MMJ$VCS:v.0614:2018 raga 32 of 61 Request for Taxpayer Fees, M W Give Fohh to the (taeJ:Navamttar?A17) Idenfiffcatio� Number tand.C401f lotion requester.nonot t3oppatftnont+ lheT+�stay- - - send-to the 1IR tnteinetHevetnro.t,etyice ►,tQ,ototyww.jrs46WA rrnftforlt tritctions.'andtheit�tesfdtlomtatibn. - f Name(aashownonymirincome tax re",Name Nmcf0Wed on-thisllnw.dn not€oave this®nobwk . CHARM 19X INC --- —— - '2 Business eamelcasragarded entity name,Y different from above BCt=ka date boieior federa€taxdassificafion of the y. PPn'W persai11ha,e nomeis ernened an It Check only one othee 4£xeritptans{bo7esapply anly to - orkitowidg seven tfpva9. m� cart i6t cntitres Hitt riitivkhutta;see SnChnduairsole ietwor' Q GG'o €tan6ts€nrcabns an page 9):•. .. p ptvpi rpara, Q SGafporaiion Q 1'aftncrsttip. 0 Trtffit/estate :ro single-member:LLC - € c .. [_Exempt payee codeW a ny). Llm€ir Habllity comparyv.Enter the taxalaesif€catton(C.-C.corporation,5-6 corporai(on,p+Partnerehlp) p Notes Mack the approprWat box In"line above for the taxclasslBoaaon of thestngle-member owner.Do trot check, Exert ticn inim FA�'CA repartlnp LLC if ihs llC is i;€assUed as asisigte•membert,LC thnt Is dtsreAarded from the agsterruntosa the owner of itiet.t_G is rode(8 aa}�j: •c.- anotlier t3.0 fhat is twttfi„rogatdad tram ttSe:ownerforV.S:tedarai tax pu[pases.Oq:enWse asingta-memoar13-c"t ..w to dlaregardedtramtho awrepca€wtdd cttackiheappropriata;tdoxtwaie tax rAassis4caUoa.afita:ov+ner: ». Q-Outer (healnstrucuor, .. - - - r+uvw�in•rounai,�atnaMa4«,ntae.dvtt3t. .6 Address(number,strap(and apt or suite no.See tnshuCHatis. :Requester a name and eiddrims(antional) vy 1616 CONEY ISLAND AVE tt qry:state,arxt ZtR'carie --- BfiOOKLYN'NY 11230 . 7 tisi atxarnt nttrntrer{s)Isere{apttanal Taxpay c TrlentRC-di ian Number frlNj inter your TIN ui:ths appropriate lox;The 11N provided must match the name:give.n on line 7 to aVOtd So ifat ecderity number backup.alien,a lrtg For int%r,Orals ttitsIs{dinthy ya•r'sacitll3acuriry.nurnber{3SN):Nawevar..tora reddenf alien,sofa proprietvt,or diaiegerded entit;sea the Insirut€ions.#or Fart 1,later,For-other englle-,it is your gmployertderdlSeaUon.number(EIN):!(you do not have a r omits,sea tfoiv to Beta TiN Naiar. oY Note:if the atx ount:Is in more than one hame,sae thd.instruckTons for line i.Also see b izatNttrhB and -S;j�1orartdpntWcat€m number NurnberTo Give the ftequegtpr for guidelines on whose numberto enter;. - .zs! 2;405 Certification Under:penaktosvf perjiky,t'cert#fytliat i,.l ho number snawn on!tits form Ts 7ny.frorraet taxpayer identification number(or I am welting for,a number to be issued to me);and ?._i am not serbjectto backup wtthhoding because:(a.)1 am exempt from backup withholding,or tbj I liave not been notified'ty the Intemal'Revenue Service{tR3}#hat i arrt su2sjec to back€ t wiif din as n result of a taitta'e to raper€all interest:nr clMdandu,:or(c)the tF33 has notified its thin I ain ito tar�tersvttjecttc bacia p wtthholdng;aitd 3_t sin a U.S:cftizen orolher U S.`person:{defined beiovA;and h:The FATcA:a de(s)a iterw on this fo#tii(Many)indicating that I am exempt from FAIt;A reportingis coma!t. Certification inahvBt#ons:You must gross.autitem 2 atiava Tf you have been no4iGat#by ttta IRS that you are ourrert(ty.sub)ect to backup vMbI oId' because you hav6 tatlod to repot€ if interest and:di+irdsnds on your tax retuai.For raal est&te traneactitins;item 2.duea non;apPry For mortgage interest acgaisHlon or atx}_nitonmant:gt.secured property,'cancellation of debt,oontributlons to an individual retirement arrangemanl U A),and-generally,payments. oU ertitart infers it and ctrtiiiertds,you are.nal reiltt(red in Sign the":aerUflCah it;butyou must prov tleYOW cbhectT tl.Sea the instructions(sir Part it,later. SIgYt 89gnatureaf. Fie.:re U :tserean 1w €rate t~ ELl\tr a< g General 1OWU606- 1s including those Tram siooka or mu.tuei SectioMods), notedn references are io the InternafRavanue Codo unless orbs vdse .Form 1099,148C&grlous types of tnco",prizes,awards,or gross. noted, proceeds) Future devolopinEnls For the latest mfomtatian aba t devalopmenf3 .Fa t?1/399 8(Stork or.muivaT tuiid ratter sriii'cedfain other related to Form W-9 and its Instructions,such us."Islation enacted after they were:pubfished,Sp toWww#rs goVlFpjmM trattsacilpits by prokttrs) Form t09�S(proceeds from feat estate.trahsactlans) Purpose of Form! Fonn'10N .(merchantcard add third party ttetwork transactions). An:inalvidua€or erxity(Form W'S rat;ttester)wha is raguYed to rile art Fonri i 088.{itbrtto ritottgage iriteieyf),.1098= (student lonn:interest); 1498 T !Hon rrt#orrnation fat um:wtth the IfRS mustobtainyourcocrecttaxpayeK � identificatron number(nN)vvftTch may be your social secor(ty nurnbor Form 1099-C(canceWd'debt): (o"SN Ttdrviduaitaxpayar identifigation num#ter(fftN)radoptlon, •Forrn lQ s Il(acgtttsi(tarr oratit tdonm&#iitaedw ad tiioper#yj taxpayer tdantiftoatlo t nttmf5er(ATih{),or:emplcyerldenhflcation number (EIN),.ta raporl on an infnrrriatlon return the amount O.Od W you,dr inner Use Fornt W 9 oniyif:you are$l3 S:parson Qncludutg a resident alien),.to:provice.your collect Ti(J: amount reportable:gn_art.intorrnatton return.etamples of informiati6n . rutorris:include;:but are no#:limited to,the roliodving.- tt you db not refu try:i�'gMT W4.10 the requester w th a Tito you riii)77pt •°Ferret 1tr99-If3T:(mtereatoa,med or paid) fxt baAAtip Withhof(rlg:See What is backup`wkhholding Iater. Cat,No.102SiX .. .. Forth W-$()Rev.1T-M,14 Cr�rpei.�tPve!!ucchas»g. 12007 Research Boulevard Austin;T"as787W-24.39.PH,8DM95-29I9�FAX;84(t-21I 5�54*§yjK�4�C 12. General compliance and Coo perati>,n vaFth tooperaUve Nlen rbers:' In additfon tp the foregoing speafic requlrements,'Vendor agrees,,in accepting..any Purchase'Order from a i✓ooperaGve member, it shall make.a good faith effort'to work with Cooperative'members to provide such infoririation.ani to satisfy: such requirements as may apply to a particular Cooperative member purchase or purchases ineitiiiirig;brit notdimified to, appiicabie recordkeepinc and record retention rerLUirements 1. 'Vendor vtoiation or Breach of'Coritratt ierr5is ___. OR 2. Termination for Cause or Convenience 3. Equa!employment Opportunity 4. .paves-Bacon Act ._ -. _.. t 5: Contract:Work i:iours and Safi::ty Standards 6. _Fright to Inventions Made Under a Contract or Agreement' 7. :Clean Air;Act and Federal Water'pollution Control Act —_........_ 8. °Debarmerit'and Suspension • _.. J: BByrdAnti:Lobbying Amendment � 10.Procurement of i2ecovered Niat>»rTals 11. Profit'as.a.5eparat:w:Element of P»ce 12>General Compliance:and Cooperation with Cooperative-Members _ . ............ ........ SY signature beidw,.T crrti€y that the information in:this form#s true,mmpfete artd accurate and Chao I arri:authorized by my company to make:thls cetOicatir n;ant3 ail'consen and agreerileftm contained`:Tiereip. Comoariy Name :Signature of Authotl;W companY.t3fficial. Printed.Name Page 36 of 61 "g6a1 Forms cor M/svcs o o6.a zaze raoperaffve P�rrcirasng 12007 Research Boulevard:•Austin,Texas:78759 Z433'PH.80Q 695 2919 t FAX:.$0©�211 5454.' y "o P-R POSAL INVI A` ION QUESTIONNAIRE The Cooperative wiil.use your responses to the questions below in evaluating:your ProposaE:and technical and flrianciai resources tta provide the goods and perform the.services ("Worm under the.:Buy.Board contract contemplated by this Proposai:Invitation("Contract". Proposers must fully:answer each question; numbering your.responses to correspond to the questions/numbers below. Proposers must complete below or attach your responses to this questionnaire,sign where indicated below,and siJbmit the signed questionnaire and your responses to ail questions in one docurrient,with your Proposal, You must submit the.signed queWonnalre and responses with your Propbsat.or.the Propuaal Will not be,considered. 1. Clst the number of years Proposer has been in business and,.former business,names:(if applicable):. Note whether your Company is currently:for sale or Involved in any transaction that would.'significantly alter.Its.business or result.ir acquisition by another entity: . Describe the resources Proposer has to manage staff;and successfully perform:the Work rgritempiated under this Contract. State:the number'and summarize the experience of company personnel who may.he utillxed for the:Work, including those who will be available to Cooperative members for assistance with project;developmerit,technical issues,:. acid product selection for Work>assoc iated with this Contract. IUY+ ... tr., 401 (i *�i CictG :. N. 1J 11zdo _ t434 otc(orj raolh Loli All 444 k ti#i+7. —&Ji ;�. I Describe Proposers. financial capability to perform the Contract, State or describe the firm's financial strength and rating,,bonding capacity, and insurance coverage lirn](&.State whether the firm, or any of fire firm's past.or p.ceserit ownersr principal shareholders or.stockholders,or officers,have.been a debtor}warty to a:ilan". tcy,receivership, or insolvency proceeding.in the last.7 years,and identify any such:debtor party by narne an i relatlpnship.to or position' with your firr€i, ) n Repo=Forms-CRMM/SVCS VA6.14.2618 Page 37 of 61 C1rapi ratiireFur*a 14# 1200.7 Research.Bou[eyard•Austin.,Toes,78759.2439 PH:800-G95 29.9.'FAX.8U4y211 5454"beard com: 4. Does your company Have any,outstanding f€nanciai ju fgments and/oris it current[y.in default on any loan or financing nt?agreeme Tf so,provide detailed information on the nature of such items and prospects.for resolution. S. fist.all.contracts,if any,in.the last 10 years on which Proposer has defaulted,::tiled to Coomplete or deliver the work;.or that have.been term€natedJor any reason. 1=or each such contract, provide the..project:name,scope;value and date and the name of the procuring.entity. (Fully explain the circumstances of the default,.fai€ure'to complete.or deliver the work,or termination. 6: Ust all fit€gation:or other.legal proceedings (including.arbitra oh:proceedir*A:if any,.in:the.last 10.year brought against your firm,or.any of the firm's past or present 1ovuriers,principal sh hviders or stockholders,officers,agents+r employees,that relates to or arises from a'contract similar to th€s Contract or:the.work ciontemplatetiI Under tli€s; Contrc Provide tesaoetyle of the.lawsuit or proceeding:(name of partles anti court or tribunal in which filed),nature of the dalm,and resolution or current status. 8y signature beMw,I;nertify fiatthe rtforrnatian t oititained lit andJor Attadwd to.this Proposal Inv."rtation Questionna'tire In respohse tO the AboVe giwsdons is true"anti correct and that 1.am authorizeA by my Company ta.marke-this:tta;+MlIca#ion. Company(dame Signature of Authorl mpany Official IVOP I FOYMS coa+rusvcsv 05.14.2018 Page.38 of 61 /Board' Propiasal. nvitation No.W-19 Conredlonal end Detentii n Facility Equipment and.Supplies (Ckt togs/PriaNisfs fyri�LLSk'+by subralitied with Proposal or Prgypoas,ai v i not ba considered.,)- ... Dlscnudt:(%).OJf. Please stawtlle:discount 0140 off catalog/i>ticelist lt.x0rair a Apparel catalogJPrioellst for and.>Ftiotrvear sneakers,canvas shoes,.uniWrim%ilimpstids stxfis Inmate Apparel and prapedyI bIags and related prdducts. Catalog/PriosIM MOSTbaldc9uded or Footwear prppowwiitt not boCondutired. Cata irit(%;Off Please state the discount(%)off cataloVitricelist:for Inmate Cnrnat M i Crest Pon Mattresses girding,and Laundry Supplies-towels,sheets, 2 Inmate Ntattresses, Bedding,.and Laundry blankets,laundry bag and related products. catalog/t+riceest 9auST,bc Supplies included or proposal will not be considered. considered. off Please state the discount(o/n)off CltalagJpriCviist fpr.Inrnatc Hygiene 3 CatakigJPricelistfgr and Petaoaatt are items-disposae razors,shaving cream,,5ar _ .°o c� i. inmate Hygiene and soap:body lotion and related products. Caudown-r illst MUST tie included Personal:t Rare items or proposal will not be considaract, Discount(%)Off Catalog/Pricerm for Pkiise state;the discount(%n)off catalog/primki far Inmate Patient Inmate Patient tints and sukldai Prevention Eiquipment:and Supplies- C j . 4 Restraints and Suicide silidde smocks and blankets,restraint beds,cuff and belts and relatedd °Jo prevention Equipment piadutt5.catalog/POtellst MUSTbe included or:proposal will riotbe a�Sliplilies' oousldered; Dismount(°k)Off Please state the dLscaunt Vt.)off catalog/pricelist for Inmate Medical 5 Catalog/Prfcelist for Supplies"110M,infect ri Control supplies,drug screen test supplies Inmate Medical Supplies ana related produds. Catataj(Prlcenatoever be included er ptopoW will mt .. .. be.considered.. . . . PROPQML NOSE PROPOSAL SPECIFtdAIXON CORM L Catalogs/Prieeiists arc requited to,be submitted with Proposal Page HO 6F 6i I Propwl invitation No;58 i-1 Corrw,tiunal and Detention Facility Equipntentand Supplies. (CafalogsJPiiceH s wazi be subinitted with proposal or Proposal'Mil not�be mnsideredi.) liscount{ilk)tiff CatalogJPriceifst for Please state the clLwount.(%)off catalog/firicelis for Correctional and 6 Correctional and Detention Faculty furniture-bed frames,mufti-purpose tables, Detention Facility visitationstadons,mold seatirig.und ralatail products.'cataloylptleaUrt' Furniture MkWr beIfidudeii&jimposalW1notbeoaarstderad. DiscouCatafo/(%)off please state tine discount k bfFcatai ricetist for Correctional and Qtalog/Piieetisf for t 3 o�R Correctional and Detention facility contraband Scanner Egpipment-hand-held. t 7 Deterluon.Fadiaty metal detectors,Waft through metal detectors,body scanners and C� Contraband Scanner relateCi_prodUCt5.Ltitafog/Frlm tf4Mboindmdedorpmpoaalwlllnbtiw Equipment congrdered. Discount(3aj Ofi CatalogiNcellst for All Please state the discount(%)off catalog/grii ahst f r All Other fi Other Correctional and Correctional and!Detention Facility Equipment atid.Supplies.. Detention Faciltty CatmogtPftcetastMUST ba tnduded or proposat will notbe cansldered: Equipment and Supplies Not to Ekceed fioUdy e for hourly tabor gate forSnstallation/Repair Service of Insfahatia»!Repair Cotr�tlonal and Detention Faclllty Equlpment,ProductsAnd a 3 a DetefCorrecc1lity - $ /Hour- and fteter,Gon FattHty .Related):tams—State the Notta Ekceed hourly labor rate(or Egtllpmerrt,Products Instaliatim/Repair Service of Equipment and Products, and Related Items p�Q�Cd€tifD7E P0.0Vd5latSPti:FVICAT10ta.PO0.M' i tatatogslPrketists are required to be suWtted with Proposes Page 41 of 61 Exhibit C—Conflict of Interest Questionnaire. CONFLICT OF INTEREST QUESTIONNAIRE Ff3R1Ul CIO. For vendor o.ing business with focal governmental.entity Ttils:questionnalre ra,loots than es:madp.to'.th.e law t] (G3 U$EIDZY 9. b}!ti:6.?3;t241ti t.eg.,gegular:Session. This questionnaire isbaing filed inawordance with Chapter 176,Locai GoverrimentGode, oa .tirsceweit by avendorwho has a businessrelattonsfiip as defined:by Section l7ti:00 {1 a)with alocaf, .governmental entity artd the veridor,meets regtiirsmertts under Section 176:006(&j:: bylaw thisguestionnaire must I�filedwiththerecords administratorof the local govetnMonte[ entity not later than the:7th business day after the date the vendor becomes awarra o€facts' thafrequireffiestaiementto:befiEed. See Seationi7a.006(a>1),LocatGovammentiGode.; A vendor commits an offense if the vend Iariowirtgly violates Section t7$o0f Local Government Code.An o fense'underthis section is.a misdemeanor. 1. Nameofdandorwhofiasabu�risssreititiartship:withlacaigovemmenialstttity; check.this box if you:are'tWiing an update-toa previous€yfiled.iquestionnafre Lj (The:law lerguires that you file;in updated completed'questionnaire with the approiiriate:titfng authoeity riot Eater titan the All businessAw afterthe date:on uihIch you hecama aware thatthe origtnagy filed quesiiontiaire.was incomplete or Inaccurate.] a Name ot local govonnent:officeiaboutwhbmtheirrfarmafidn.I thissectian.is being disclose.!. 1� Name of officer This section(item 3 including subparts A,B,G,&b) must be completed for,each,officer with whom the vendor has an striptnymant or other business relationship as defined_by Section 178.04i(1-a},Looai.Qrn+emment Code. Atlach additional pages to this Form CTQ as necessary A. Is the local government officer named'in this sectiort receiving or ilkiily to receive taxable inoonie,other than Investment: income,from the vendor? Yss No B. Is the'vendor.recetving or likely to receive taxable incomie,.other than investment 1roorno,troth.or.st the directlon.of the.local govemrnent.of oeir',amed in:thiscti seon'A D die taxable income fs"not,received from thr lasat governmental:entity2 Q Yes Q.No C.. Is the fifer of_this questionnaire employed by a corporation or other business.ehtity*K res peat,to which-the local government'offlcar serves as an Ader.or.director,or holds an ownership interest of one petcent ar more? Yes F:Na D..Despribe each employment or business Lind-timify'relafionship with the total oovernment officer natnarl in this:section'_ a sionahure of ve i daing iwsiriess with the govemmenlia entity Date Adopted 8012015